Six in 10 people who use complementary and alternative medicine (CAM)
therapies as sleep aids also use conventional treatment such as hypnotic
medications and cognitive-behavioral therapy to help their sleep, a nationwide
health survey shows.
Little is known about the efficacy of CAM therapies for sleep, according to
Nancy Pearson, Ph.D., and colleagues at the National Center for Complementary
and Alternative Medicine at the National Institutes of Health.
As a first step toward obtaining that information, Pearson's group examined
the use of CAM therapies as sleep aids by respondents to the 2002 National
Health Interview Survey. The researchers reported their findings in the
September 18 sleep theme issue of the Archives of Internal
Some 31,044 adults, a representative sample of the U.S. civilian
community-dwelling population, responded to the survey, conducted face to face
in English or Spanish by the National Center for Health Statistics of the
Centers for Disease Control and Prevention.
About 17.4 percent of respondents reported that they "regularly had
insomnia or trouble sleeping" in the preceding 12 months. Even though"
trouble sleeping" could encompass disorders other than insomnia,
that figure falls within the wide range of previous estimates of the
prevalence of insomnia in the United States. It extrapolates to an estimated
36 million American adults. The survey did not ask about the severity of sleep
More women (61 percent) than men (39 percent) reported difficulty sleeping.
Sleep problems peaked in those aged 45 to 54, then declined, and rose again
only in those aged 85 and older. This finding differs from those of earlier
studies that suggested people in their 60s and 70s have more trouble sleeping
than do younger adults.
People with anxiety or depression were five times more likely to report
poor sleep than people without those disorders. Congestive heart failure
doubled the risk of poor sleep, while hypertension and obesity increased it
slightly, compared with not having those health problems.
Poor sleepers reported worse health overall. Nearly 96 percent of them
reported having one or more of 50 medical disorders listed on the survey. By
comparison, 30 percent of those who said they had no sleep problems said they
had none of those disorders.
Insomnia associated with other disorders, once labeled"
secondary," now usually is called "comorbid." The new
usage reflects recognition that sleep problems may exacerbate or even play a
contributory role in psychiatric and other illnesses, as is thought to occur
between insomnia and depression, for example.
About 4.5 percent of people who reported chronic insomnia or trouble
sleeping—an estimated 1.6 million adults—said they used one or
more of 27 CAM therapies.
CAM therapies, the researchers noted, include "medical practices that
are unproven by science and not presently considered an integral part of
conventional medicine." About two-thirds of CAM therapies are
biologically based; these include vitamins, herbs, and hormones such as
melatonin. Mind-body techniques, including biofeedback, relaxation,
visualization, hypnosis, yoga, and meditation, comprise the majority of other
Nearly two-thirds of CAM users said they had tried biologically based
therapies for sleep. Nearly 40 percent said they had used mind-body therapies.
Younger adults and those with higher educational attainment—people most
apt to use CAM therapies in general—also were the highest users of such
therapies for sleep.
When asked why they had used CAM therapy, two-thirds of respondents said
they thought it would be interesting to try. Nearly as many said they thought
combining CAM and conventional treatment would be helpful. The survey did not
ask respondents which conventional therapies they used to aid sleep or which
ones they used in conjunction with CAM therapies.
Nearly 40 percent of CAM users had not told their conventional medical
practitioner they used such therapy to aid sleep, while 35 percent reported
that a conventional medical professional had suggested they try a CAM
Nearly half of those who used herbal therapies or relaxation
therapy—the CAM approaches most often used to aid sleep— said they
felt that such therapies "helped their condition a great
More than half of CAM users rated such therapy as "very
important" to maintaining their health and well-being.
The survey does not directly address the efficacy of CAM therapies, the
researchers acknowledged. Users' positive perception of benefits of CAM
therapies, they said, "could be due to a placebo effect, the natural
history of the condition, or other unidentified influences rather than
efficacy of the CAM treatment."
In an accompanying editorial, Phyllis Zee, M.D., Ph.D., and Fred Turek,
Ph.D., both of the Northwestern University Feinberg School of Medicine, noted
that medications used in the routine care of patients with medical,
neurological, and psychiatric disorders sometimes cause insomnia.
Four in 10 respondents in the Pearson study said they tried a CAM therapy
for sleep because conventional treatments had not proved helpful.
An abstract of "Insomnia, Trouble Sleeping, and Complementary
and Alternative Medicine" can be accessed at<http://archinte.ama-assn.org/cgi/content/abstract/166/16/1775>.▪